Introduction
Epilepsy is a brain disorder where the nerve cells do not signal properly, therefore causing seizures. Seizures can be defined as unregulated bursts of electrical activities which alter the sensations, emotions, behaviour, awareness and movement of muscles. In epilepsy, repeated seizures occur as a result of damaged brain cells producing abnormal electrical signals.
When surges of electrical activity in the brain cause recurring/ repetitive seizures in an individual, one is said to have epilepsy. (It is characterized by periodic and unpredictable occurrence of seizures).
Currently, epilepsy does not have a cure. Despite this, it can be managed by medications in about 70% of the patients. Epilepsy is also referred to as a seizure disorder.
Any person, of any ethnicity, sex or age can easily develop epilepsy.
Key Facts & Statistics
What are the key facts and statistics about epilepsy?
- Globally, epilepsy is the fourth most common neurological disorder.
- It is not a rare disorder. It is estimated that 1 in 26 persons will develop epilepsy during their lifetime.
- It is not contagious. It cannot be transferred from one person to another.
- Epilepsy can occur alongside various other health conditions, such as:
- Autism.
- Cerebral palsy.
- Alzheimer’s disease.
- Traumatic brain injury.
- Stroke.
- According to the World Health Organization (WHO), epilepsy is a chronic non-communicable brain disease which affects all age groups.
- Around 50-65 million people worldwide have epilepsy.
- 8 out of 10 people with epilepsy live in low and middle income countries (LMIC).
- The risk of dying prematurely in individuals with epilepsy is up to three times higher as compared to the general population.
- In most parts of the world, epilepsy patients and their families have been stigmatized and discriminated.
- It is estimated that 5 million people are diagnosed with epilepsy every year.
- 3 million adults and 400, 000 children in the United States have epilepsy. Each year, 150,000 new cases emerge.
Causes & Seizure Triggers
What are the causes of epilepsy?
- In up to 7 out of 10 epilepsy cases, the cause of the seizure is usually not known.
- Known cause include:
- Genetics.
- Head injuries.
- Immune disorders.
- Brain infections.
- Brain conditions and abnormalities of brain vessels.
- Metabolic disorders.
- Mesial temporal sclerosis.
- Developmental disorders.
Genetics. Some types of epilepsy such as juvenile myoclonic epilepsy and childhood absence epilepsy are more likely to be inherited along a family line.
Head injuries. These can result from sports activities or vehicle accidents.
Immune disorders. Auto-immune conditions (where the immune system attacks brain cells) can lead to epilepsy.
Brain infections. Examples include meningitis and neurocysticercosis.
Metabolic disorders. Individuals with metabolic conditions can also have epilepsy.
Mesial temporal sclerosis. This is a scar which forms in the inner part of the temporal lobe. It can give rise to focal seizures.
Developmental disorders. Birth defects that affect the brain can lead to development of epilepsy. Examples are: polymicrogyria and tuberous sclerosis.
Signs & Symptoms
What are the signs and symptoms of epileptic seizures?
Epilepsy is mainly characterized by recurring seizures. Symptoms can vary depending on the kind of seizure.
The following are some of the signs and symptoms of a seizure:
- Psychic symptoms:
- Fear.
- Dread.
- Deja vu.
- Anxiety.
- Inability to talk properly.
- Faster heart rate (tachycardia) and breathing (tachypnea).
- Smacking of the lips.
- Temporary loss of consciousness or awareness.
- Unregulated muscle movements and loss of muscle tone.
- Changes in hearing, taste, smell and vision.
- Feeling of numbness and tingling.
- Goosebumps.
Most individuals who have epilepsy tend to have the same type of seizure, and therefore each seizure presents with similar symptoms as the previous ones.
What are seizure triggers?
Seizure triggers are occurrences that take place before a seizure begins.
Examples are:
- Illness, fever.
- Stress.
- Sleep disorders such as sleep apnea.
- Flashing lights.
- Intake of specific foods such as caffeine.
- Certain medications such as diphenhydramine.
- Missed anti-seizure medication doses.
- Physical overexertion.
- Dehydration.
Types
What are the most common types of epilepsy?
There are two most common classes of seizures:
- Focal onset seizures.
- Generalized onset seizures.
Focal onset seizures
2 sub-classes within this class are:
- Focal onset aware seizure.
- Focal onset impaired awareness seizure.
Generalized onset seizures
There are 6 types of generalized seizures:
- Absence seizures.
- Atonic seizures.
- Tonic seizures.
- Clonic seizures.
- Tonic-clonic seizures.
- Myoclonic seizures.
Diagnostic Procedures & Tests
How is epilepsy diagnosed?
If an individual experiences at least 3 seizures that were not caused by a known medical condition (for example hypoglycemia or low blood sugar level), he or she is considered as an epileptic person.
For a proper medical diagnosis, the health-care practitioner:
- Performs a physical examination.
- Takes a proper medical history including symptoms that occur during a seizure( anamnesis). An informant such as a close relative or family member who has witnessed the seizure is needed to answer such questions.
- Orders blood tests to rule out other causes.
An informant may be asked if they noticed any of the following symptoms as they witnessed your seizure:
- Muscle stiffness.
- Changes in breathing pattern.
- Loss of consciousness.
- Blank stare.
- Muscle jerks.
- Problems with talking.
- Loss of bladder control (if the patient urinated during the seizure).
- Loss of bowel control (defecation during a seizure).
Diagnostic Tests
Which tests are conducted to diagnose epilepsy?
The following are the tests that can be conducted in order to diagnose an individual with epilepsy:
- Electroencephalography/ Electroencephalogram (EEG).
- Brain scans.
Electroencephalography/ Electroencephalogram (EEG)
An EEG is a test that is used to measure the electrical activity in the brain. Specific abnormal electrical patterns can be related to seizures.
Brain scans
An MRI (magnetic resonance imaging) can be conducted to look for tumors, infections or blood vessel abnormalities in the brain.
Treatment and Management
Does epilepsy have a cure?
Currently, epilepsy does not have a cure. Despite this, it can be managed by medications in about 70% of the patients.
How is epilepsy treated?
Treatments used to control this condition are:
- Anti-seizure drugs.
- Special diets (as an add-on option to anti-seizure drugs).
- Surgery.
Anti-seizure drugs
- Benzodiazepines.
- Carbamazepine.
- Diazepam.
- Gabapentin.
- Lamotrigine.
- Valproic acid.
- Phenytoin.
- Pregabalin.
- Oxcarbazepine.
Choice of medicines depends on:
- Type of seizure.
- Prior response to anti-seizure drugs.
- Potential drug-drug and drug-food interactions.
- Adverse effects.
- Cost.
- General health.
Special diets
For epileptic patients, two most common diets that are recommended are:
- The ketogenic diet.
- Atkins diet. This is high in fats, moderate in protein and low in carbohydrates.
Surgery
This is recommended when :
- Anti-seizure drugs are not able to control the seizures.
- The seizures are severe and debilitating.
Surgical options include:
- Surgical resection. Abnormal tissue is removed.
- Disconnection. Fiber bundles that connect areas of the brain are cut.
- Stereotactic radiosurgery. Abnormal brain tissue is targeted and destroyed.
- Implantation of neuromodulation devices. These devices are used to send electrical impulses to the brain so as to reduce seizures over time.
Seizure First Aid
- Stay with the patient and start timing the seizure.
- Keep the person safe by removing any objects around.
- Turn the person onto his/her side if they are not awake or aware.
- Do not put anything such as food or drinks in their mouth.
- Do not restrain the patient.
- Stay with them until they recover from the seizure, awake and alert.
- Contact 911 or any other medical emergency helpline if the;
- Seizure lasts more than 5 minutes.
- Patient has repeated seizures.
- Patient has difficulty breathing.
- Seizure occurs in water. For example, a swimming pool.
- Person in injured, ill or expectant.
- Seizure is the first to occur in the person’s life.
- Person does not return to their usual state.
- Patient asks for medical assistance.
Prevention
How do we prevent epilepsy?
- 25% of epilepsy cases can be prevented. For example, head injuries as a result of sports injuries and traffic accidents, which can be avoided. Preventing head injuries is the most effective way to avoid post-traumatic epilepsy.
- Individuals with a history of drug and substance abuse are advised to seek therapy, as this drugs can damage the brain and lead to epilepsy.